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Role of staphylococcal superantigens in upper airway disease

Bachert, Claus; Zhang, Nan; Patou, Joke; van Zele, Thibaut; Gevaert, Philippe

Current Opinion in Allergy and Clinical Immunology: February 2008 - Volume 8 - Issue 1 - p 34–38
doi: 10.1097/ACI.0b013e3282f4178f
Upper airway disease: Edited by Ruby Pawankar and David P. Skoner
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Purpose of review Chronic rhinosinusitis with nasal polyps often represents a chronic severe inflammatory disease of the upper airways and may serve as a model for lower airway diseases such as late-onset intrinsic asthma. Enterotoxins derived from Staphylococcus aureus have been implicated in the pathophysiology of nasal polyps as disease-modifying factors; recent findings using therapeutic proof-of-concept approaches support this hypothesis.

Recent findings Nasal polyps (chronic rhinosinusitis with nasal polyps) are characterized by a T-helper-2 dominated cytokine pattern that includes interleukin-5 and formation of immunoglobulin E. This is in contrast to chronic rhinosinusitis without polyps, which exhibits T-helper-1 biased cytokine release. It is now evident that the cytokine environment is decisive regarding the impact of S. aureus derived enterotoxins, which function as superantigens. S. aureus enterotoxin B further shifts the cytokine pattern in nasal polyps toward T-helper-2 cytokines (increases greater than twofold for interleukin-2, interleukin-4 and interleukin-5), but it disfavours the T-regulatory cytokines interleukin-10 and transforming growth factor-β1. Furthermore, S. aureus derived enterotoxins influence local immunoglobulin synthesis and induce polyclonal immunoglobulin E production, which may contribute to severe inflammation via activation of mast cells.

Summary From this new understanding of chronic rhinosinusitis with nasal polyps, new therapeutic approaches emerge such as anti-interleukin-5, anti-immunoglobulin E, and antibiotic treatment. These may enlarge the nonsurgical armentarium.

Upper Airway Research Laboratory, Ear Nose and Throat Department, University Hospital Ghent, Ghent, Belgium

Correspondence to Prof Dr Claus Bachert, MD, PhD, Head, Upper Airway Research Laboratory, Chief of Clinics, ENT-Department, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium E-mail: claus.bachert@ugent.be

Copyright © 2008 Wolters Kluwer Health, Inc. All rights reserved.